Fluorescein Angiography Research Articles

Suprachoroidal Triamcinolone Acetonide for Noninfectious Uveitis: Real-World Impact on Clinical Outcomes

PurposeTo evaluate clinically relevant outcomes following suprachoroidal triamcinolone acetonide (TA) injection in eyes with noninfectious uveitis. DesignRetrospective interventional case series. Methods61 eyes (51 patients) who underwent suprachoroidal TA injection between January 1, 2022 and July 1, 2024 were included from a single institution. Main outcome measures included change in central subfield thickness (CST) and best-corrected visual acuity (BCVA) at 6, 12, and 24 weeks in eyes with macular edema and improvement in fluorescein angiography (FA) score at 6 weeks in eyes who underwent FA. Results52 eyes underwent suprachoroidal TA injection for uveitic macular edema. Mean CST improved from 437.61 microns at time of injection to 348.17 microns 6 weeks after (mean difference 89.44 microns, p<0.0001, n = 47). Additional treatment for macular edema was required for 17% (8/48 eyes), 48% (14/29 eyes), and 41% (9/22 eyes) of eyes that returned for follow-up at 6, 12, and 24 weeks, respectively. Of the 17 eyes that returned for follow-up at all visits (6, 12, and 24 weeks), 41.2% (7/17 eyes) did not require any additional treatment during the 24 week follow-up period. 10 eyes underwent FA at time of injection and 6 weeks later. The mean FA score improved from 11.74 to 9.14 (mean difference 2.60, p=0.047). No serious adverse events occurred. ConclusionsSuprachoroidal TA resulted in significant improvement in outcome measures, including central subfield thickness in eyes with macular edema, and leakage on fluorescein angiography, with a favorable side effect profile in real-world clinical practice.

Incorporating a poly-ε-caprolactone scaffold in a stapled small intestinal anastomosis with induced ischemia significantly increased anastomotic tensile strength. An experimental study in pigs

Objective Anastomotic leakage is a severe complication with multifactorial aetiology, including impaired tissue oxygenation, infection, inflammation, and anastomotic tension. Reinforcement with poly-ε-caprolactone (PCL) scaffold incorporated in a stapled intestinal anastomosis has demonstrated a significant increase in the anastomotic tensile strength. This study aimed to investigate whether incorporation of the scaffold would influence tensile strength with induced ischemia compared to normal blood perfusion. Methods Eighteen pigs were randomly allocated into an intervention group with a induced relative reduction in blood perfusion to 30% at the anastomotic area and a control group with normal perfusion controlled by quantitative fluorescence angiography. Each pig recieved two stapled small intestinal anastomoses, one with a PCL scaffold incorporated and one without. On postoperative day five, the anastomoses were subjected to a maximal tensile strength test (MATS) and a histopathological analysis. Tensile strength was measured at three events: when a serosal tear became visible (MATS-1), at transmural rupture (MATS-2), and at maximum load before the load-strain curve dropped (MATS-3). Results In the intervention group, MATS-1 was significantly higher in scaffold-reinforced anastomoses compared to controls (7.9 ± 4.2N and 4.4 ± 2.5N, p < 0.02). The same tendency was found for MATS-2 and MATS-3, with statistically significant differences after adjusting for adhesion grade (p < 0.05). Histological analysis revealed no significant differences in wound healing between groups. Conclusion Incorporating a PCL scaffold in a stapled small intestinal anastomosis with induced ischemia improved anastomotic tensile strength.

Dynamic three dimensional environment for efficient and large scale generation of smooth muscle cells from hiPSCs

BackgroundChronic ischemic limb disease often leads to amputation, which remains a significant clinical problem. Smooth-muscle cells (SMCs) are crucially involved in the development and progression of many cardiovascular diseases, but studies with primary human SMCs have been limited by a lack of availability. Here, we evaluated the efficiency of two novel protocols for differentiating human induced-pluripotent stem cells (hiPSCs) into SMCs and assessed their potency for the treatment of ischemic limb disease.MethodshiPSCs were differentiated into SMCs via a conventional two-dimensional (2D) protocol that was conducted entirely with cell monolayers, or via two protocols that consisted of an initial five-day three-dimensional (3D) spheroid phase followed by a six-day 2D monolayer phase (3D + 2D differentiation). The 3D phases were conducted in shaker flasks on an orbital shaker (the 3D + 2D shaker protocol) or in a PBS bioreactor (the 3D + 2D bioreactor protocol). Differentiation efficiency was evaluated via the expression of SMC markers (smooth-muscle actin [SMA], smooth muscle protein 22 [SM22], and Calponin-1), and the biological activity of the differentiated hiPSC-SMCs was evaluated via in-vitro assessments of migration (scratch assay), contraction in response to the treatment with a prostaglandin H2 analog (U46619), and tube formation on Geltrex, as well as in-vivo measurements of perfusion (fluorescence angiography) and vessel density in the limbs of mice that were treated with hiPSC-SMCs after experimentally induced hind-limb ischemia (HLI).ResultsBoth 3D + 2D protocols yielded > 5.6 × 107 hiPSC-SMCs/differentiation, which was ~ nine-fold more than that produced via 2D differentiation, and flow cytometry analyses confirmed that > 98% of the 3D + 2D-differentiated hiPSC-SMCs expressed SMA, > 81% expressed SM22, and > 89% expressed Calponin-1. hiPSC-SMCs obtained via the 3D + 2D shaker protocol also displayed typical SMC-like migratory, contraction, and tube-formation activity in-vitro and significantly improved measurements of perfusion, vessel density, and SMA-positive arterial density in the ischemic limb of mouse HLI model.ConclusionsOur dynamic 3D + 2D protocols produced an exceptionally high yield of hiPSC-SMCs. Transplantation of these hiPSC-SMCs results in significantly improved recovery of ischemic limb after ischemic injury in mice.

Novel Multimodal Imaging in Bilateral Diffuse Uveal Melanocytic Proliferation and Change in the Findings During Follow-up and Treatment.

To describe the advanced multimodal imaging findings of patients with bilateral diffuse uveal melanocytic proliferation (BDUMP) and the changes in these findings over time. Fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FA), spectral domain optical coherence tomography (OCT), B-scan ultrasonography (US), and ultrasound biomicroscopy (UBM) images of the patients diagnosed with BDUMP at a single institution between years 2006-2023 were evaluated. Sixteen eyes of 8 patients with BDUMP were included. The median age was 68 years (Range: 49 - 77 years), and the median follow-up time was 11 months (Range: 1 - 79 months). The most common fundus photography findings were pigmentary changes and diffuse orange pigment patches in the posterior pole. The giraffe/leopard pattern of hyperfluorescence on the posterior pole was the most prominent finding in FAF and FA. Different from previous reports, intraretinal hyperreflective foci, outer retinal tubulations, subretinal fibrosis, and bacillary layer detachment in OCT; optic disc hyperfluorescence, and peripheral vascular leakage in FA; 360° ciliary body thickening, and anterior rotation of the ciliary body in UBM were detected. We presented various novel multimodal imaging features of BDUMP that may warrant updating current diagnostic criteria and their changes over time. Our newly defined findings also suggest a possible inflammatory component to BDUMP pathogenesis, which may have implications for treatment.

Multimodal imaging features of retinal neovascularization in response to 3 anti-VEGF injections

ObjectiveTo analyze longitudinal changes of retinal neovessels (NV) in eyes with proliferative diabetic retinopathy (PDR) after 3 monthly intravitreal injections (IVI) of ranibizumab by means of different imaging modalities, particularly focusing on optical coherence tomography (OCT) and OCT–angiography (OCT-A) features. MethodsProspective, monocentric study, Luigi Sacco Hospital, Milan. Consecutive patients with PDR were enrolled. All patients underwent color fundus photography (CFP), fluorescein angiography (FA), SD-OCT, and OCT-A at baseline (t0) and after 3 monthly IVI of ranibizumab (t1). Neovessels (NVs) were classified as flat, elevated, flat-elevated, or table-top using OCT scans and further analyzed on FIJI. Qualitative and quantitative NV characteristics were evaluated. Vessel density (VD) was calculated as the mean of all the white pixels of the NV and expressed as a percentage of the area of the NV (VD = NV area × 100). ResultsThirty-six NVs in 10 patients were studied. The regression of NVs at t1 was partial in 66.7% of cases and complete in 33.3%. Table-top NV demonstrated more frequently a complete regression (P = .03). A significant reduction of the NV area, perimeter, and VD was observed at t1 (P < .001). NVs that showed a complete regression had higher mean VD values at t0 compared with NVs, which showed a partial regression (P = .02). Flat NVs had more frequently a complete vitreous attachment, while table-top showed more often a partial vitreous detachment with focal NV adhesion (P < .05). A complete regression was more often observed for NVs with a partial vitreous detachment and focal NV adhesion at t0 (10/12), while most of the NVs with a complete vitreous attachment showed a partial regression (18/24) (P < .001). ConclusionsThe table-top configuration of the neovessel, higher VD values at baseline, and the presence of a focal adhesion of the vitreous over the NV were factors associated with a higher risk of complete regression of the NV in response to 3 monthly IVI of ranibizumab.

Successful use of PRGF-endoret® and ILM peeling for full thickness macular hole in MacTel type 2: A case report and review of literature.

To describe the successful use of plasma rich in growth factors (PRGF-Endoret®) and internal limiting membrane peeling for full thickness macular hole in Macular Telangiectasia type 2. A case report of a full thickness macular hole (FTMH) associated with Macular Telangiectasia (MacTel) type 2 is described. 25-G vitrectomy with internal limiting membrane (ILM) peeling and use of (PRGF-Endoret®) was performed. Several ophthalmological visits were conducted and multiple diagnostic tests were carried out including optical coherence tomography (OCT) and fluorescein angiography. A 72-year-old man under follow-up for MacTel type 2 presented with worsening vision in his left eye, with a best visual corrected acuity (BVCA) of 20/80. OCT demonstrated a FTMH in the left eye measuring 264 µm. A 25-gauge pars plana vitrectomy surgery was performed with ILM peeling, use of PRGF-Endoret® and tamponade with 20% sulfur hexafluoride (SF6). Three weeks after surgery, complete anatomical closure was observed with a BVCA of 20/40, which improved to 20/25 one year after the surgery. The use of PRGF associated with ILM peeling may be a useful tool in the treatment of macular holes associated with MacTel Type 2 with excellent anatomical and functional outcomes.

Resolution of Angiographic Macular Leakage with Faricimab Versus Aflibercept in Patients with Diabetic Macular Edema in YOSEMITE/RHINE

To evaluate if dual angiopoietin-2 (Ang-2)/vascular endothelial growth factor-A (VEGF-A) inhibition with faricimab resulted in greater macular leakage resolution versus aflibercept in patients with diabetic macular edema (DME). Post hoc analysis of macular leakage assessments prespecified in the YOSEMITE/RHINE (NCT03622580/NCT03622593) phase 3 trials. Adults with visual acuity loss due to center-involving DME. Patients were randomized 1:1:1 to faricimab 6.0 mg every 8 weeks (Q8W), faricimab 6.0 mg according to a personalized treat-and-extend-based regimen (T&E), or aflibercept 2.0 mg Q8W. This analysis included the first 16 weeks (head-to-head dosing period) when all patients received assigned study drug Q4W; patients were assessed 4 weeks after receiving 4 doses of assigned study drug Q4W. Macular leakage area on fluorescein angiography assessed by a reading center; proportion of patients with resolution of macular leakage (defined as macular leakage area 0-1 mm2) and high macular leakage (defined as macular leakage area ≥ 10 mm2) at baseline and week 16; and the proportion of faricimab T&E patients receiving Q16W dosing at week 52 among those with resolution of and high macular leakage at week 16. Among patients with macular leakage data available at baseline, there were 1216 patients in the pooled faricimab (Q8W + T&E) arms and 593 patients in the aflibercept arm. Baseline median macular leakage area was similar between the faricimab (24.6 mm2) and aflibercept arms (25.6 mm2). At week 16, median macular leakage area was 3.6 mm2 with faricimab versus 7.6 mm2 with aflibercept (nominal P < 0.0001). More faricimab-treated patients (28%) achieved resolution of macular leakage versus aflibercept at week 16 (15%; nominal P < 0.0001). In the faricimab T&E arm, 63% of patients with resolution of macular leakage and 45% of patients with high macular leakage at week 16 achieved Q16W dosing at week 52 (nominal P < 0.01). Faricimab demonstrated greater macular leakage resolution versus aflibercept during head-to-head dosing. These findings suggest that dual Ang-2/VEGF-A inhibition promotes vascular stability beyond VEGF inhibition alone, supporting faricimab's potential to offer greater disease control and extend durability for patients with DME.

Central retinal artery occlusion following surgery for thyroid eye disease: A case report.

Thyroid eye disease (TED) is the most common orbital disorder in adults and significantly affects patient health. Orbital decompression surgery is an important treatment option. Central retinal artery occlusion (CRAO) after orbital medial wall decompression is rare in patients with TED. Therefore, the earlier the identification and treatment, the more likely it is to reduce visual impairment. This paper examines a case of CRAO occurring postoperatively in a patient who underwent medial wall orbital decompression for TED. Central retinal artery occlusion. During the operation, the pupil was dilated, and eye massage and peribulbal injection of atropine were performed immediately. Fundus fluorescein angiography suggested the possibility of CRAO. Intravenous methylprednisolone 1000 mg, mannitol 50 g, ginkgo biloba extract 20 mL, nimodipine 20 mg tid, cobamamide 0.5 mg tid, and oral citicoline 0.2 g tid, along with periocular injection of atropine and hyperbaric oxygen therapy were also administered. Fifteen days after onset, the patient's retinal edema and retinal blood perfusion greatly improved. The patient's visual acuity recovered from counting fingers to 0.6. Retinal vascular obstruction is a serious threat to vision; therefore, early detection and treatment are very important.

A cross-sectional study of fundus lesion characteristics in patients with acute visual impairment caused by COVID-19 infection

To investigate the characteristics of acute visual dysfunction and fundus lesions in patients with COVID-19 pneumonia. A retrospective case series study was conducted. Data from 48 patients (96 eyes) with COVID-19 infection who presented to our ophthalmology department with acute onset visual disturbance between December 5, 2022, and February 28, 2023 were collected. Asymptomatic patients and those who had already recovered were excluded. Data collected included patient demographics, ophthalmic examinations, multicolor imaging (MCI), infrared autofluorescence (IR), spectral-domain optical coherence tomography (OCT), fundus fluorescein angiography (FFA). Of the 48 patients, 15 were male and 33 were female, with a mean age of 32 years. All patients had bilateral involvement. OCT showed hyperreflective signals in the outer plexiform layer and outer nuclear layer of the macular region in all 96 eyes of 48 patients (100%). Additionally, 66 eyes of 33 patients (68.8%) of eyes demonstrated abnormal reflectivity in the ellipsoid and interdigitation zones. MCI revealed petaloid or wedge-shaped hyperreflective areas in the macula in 46 (47.9%) of eyes, corresponding to hyporeflective areas on IR. Cotton-wool spots were observed in the peripapillary or posterior pole area in 54 (56.3%) of eyes. COVID-19 infection can lead to acute, bilateral, symmetric, and widespread retinal damage. Characteristic findings can be observed in ophthalmological examinations such as OCT, MCI, and IR.

Clinical evaluation of real-time artificial intelligence provision of expert representation in indocyanine green fluorescence angiography during colorectal resections

Clinical evaluation of real-time artificial intelligence provision of expert representation in indocyanine green fluorescence angiography during colorectal resections

THE CONNECTION OF LOCAL RETINAL DETACHMENT IN THE MACULAR AREA WITH THE FOSSA OF THE OPTIC DISC. DIFFERENTIAL DIAGNOSIS (CLINICAL CASE)

Relevance. The optic nerve pit is a congenital disease manifested by a depression in the disc of the optic nerve, which affects about 0.9% of the population. Complications occur in 25–75% of patients and may include retinal detachment. The causes of detachment remain unclear, but two theories of the occurrence of this complication have been put forward. Fluorescence angiography and optical coherence tomography are used for diagnosis. The treatment of retinal detachment in ONDP is not standardized and includes laser treatment, vitrectomy and other methods for fluid drainage. It is important to differentiate ONDP from other causes of central retinal detachment.Objective. Based on a clinical case, to demonstrate an approach to the diagnosis and treatment of local retinal detachment in the macular area associated with the fossa of the optic disc.Materials and methods. This article presents a clinical case of retinal detachment in the macular area associated with the fossa of the optic disc. Results and discussions. When comparing two clinical cases, the similarity of the ophthalmoscopic picture and the differences in the OCT and FAG images were revealed.Conclusions. The accumulation of fluid under the neuroepithelium is not a pathognomic sign, therefore it is important to carry out differential diagnosis in central serous retinal detachment associated with the fossa of the optic disc.

ROLE OF ISCHEMIA IN THE PATHOGENESIS OF DIABETIC VITREOPAPILLARY TRACTION SYNDROME

Objective: to evaluate the role of ischemia in the pathogenesis of diabetic vitreopapillary traction syndrome.Material and methods: The analysis is based on a sample of 30 patients with diabetic vitreopapillary traction syndrome. The study included a standard ophthalmological examination, color doppler mapping, fluorescent angiography. All patients underwent three-port vitrectomy to eliminate traction syndrome.Results: The results of the obtained data indicated that patients with diabetic vitreopapillary traction syndrome had significant changes in the hemodynamics of the eye compared to the normal parameters. А significant difference in a blood flow parameters in the posterior short ciliary arteries system was recorded in eyes with vitreopapillary traction syndrome compaired to paired eyes.Conclusion: The results of the studies indicate that patients with diabetic vitreopapillary traction syndrome have significant changes in regional hemodynamics: a decrease in blood flow velocity in the central retinal artery, posterior short ciliary arteries and an increase in peripheral vascular resistance, which indicates ischemia of the optic nerve head and may also be one of the reasons for the development of vitreopapillary traction.

Optic disc and peripapillary tumors

Abstract This review covers the tumors either originating or seen close to the optic disc in the peripapillary area. Most of the optic disc tumors are diagnosed on clinical examination. In a few atypical cases, ancillary imaging, such as optical coherence tomography, fluorescein angiography, and ultrasonography, may be required to demonstrate characteristic features. The majority of these tumors have systemic associations, and hence, a multidisciplinary approach involving ocular oncologists, neurophysicians, radiation oncologists, and medical oncologists is the need of the hour. The treatment of optic disc tumor is challenging due to its proximity to critical areas such as optic nerve and macula, which could be a limiting step when compared to conventional treatments such as laser photocoagulation and surgical excision.

Bilateral multifocal inner retinitis following a viral illness, likely Covid-19.

To describe a young female patient who presented with unilateral vision loss with multiple bilateral inner retinal lesions after a non-specific viral illness, likely Covid -19. Case Report: We reviewed the medical record, examined the retina, OCT images and fundus fluorescein angiogram of the patient along with the relevant medical literature. The patient presented to our Emergency Department at Moorfields Eye Hospital with a two-week history of new onset floaters and blurred vision in her right eye. On examination she was found to have a low grade bilateral vitritis, mild right optic nerve head swelling and multiple white inner retinal lesions in both eyes. Retinitis can be due to multiple infectious and non-infectious aetiologies. In this case report we discuss a case of rare multifocal inner retinitis from a non-specific viral illness - likely COVID -19.

Frequency of Central Serous Chorioretinopathy in a Tertiary Care Center in Pakistan.

Central serous chorioretinopathy (CSC) is a significant cause of vision loss in men aged 20 to 60, characterized by serous detachment of the neurosensory retina from the retinal pigment epithelium (RPE). This study aims to assess the frequency of CSC among patients at a tertiary care center in Pakistan, offering insights into its epidemiology and management within this setting. A retrospective observational study was conducted at the ophthalmology department of a tertiary care center from January 2019 to December 2023. Patients aged 20 years and above diagnosed with CSC based on clinical examination, fluorescein angiography (FA), and optical coherence tomography (OCT) were included. Data were collected from electronic medical records, encompassing demographic, clinical, and treatment information. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 25 (IBM Corp.,Armonk, NY, USA) with descriptive statistics summarizing demographic and clinical characteristics, and chi-square tests and t-tests examining associations between variables. A total of 83 patients (112 eyes) were studied, with 83.13% being male and 16.87% female. Unilateral CSC was observed in 65.06% of cases, while 34.94% had bilateral involvement. The age group 25-40 years had the highest incidence (57.83%), with Unani medication (39.58%) and systemic hypertension (45.71%) being the most common contributing factors. The most frequent presenting symptom was vision impairment (48.19%). CSC primarily affects middle-aged men, with observed associations to factors such as traditional Unani medication and systemic hypertension. This study highlights the importance of tailored treatment strategies and the need for further research into CSC's pathogenesis and management in Pakistan.

PRPH2-ASSOCIATED RETINAL DISEASES: A SYSTEMATIC REVIEW OF PHENOTYPIC FINDINGS

PurposePRPH2-associated retinal diseases (PARD) result from pathogenic PRPH2 variants, primarily affecting photoreceptor outer segments and retinal pigment epithelium. The focus of this article is to review and discuss the phenotyping of PARD subtypes. DesignA systematic review MethodsThe review followed PRISMA 2020 guidelines with searches on PubMed, Medline, Web of Science, Google Scholar, and Cochrane Library. Eligible studies were those which discussed molecularly confirmed PARD or described associated diseases such as butterfly pattern dystrophy. Inclusion: cross-sectional, cohort, case-control studies, book chapters. Exclusion: non-English, conference papers, non-peer-reviewed, or non-full text articles. ResultsPARD is responsible for 25% of pattern dystrophy and up to 5% of inherited retinal dystrophies. There is clear evidence of phenotypic variability between individuals carrying the same pathogenic variant. Fundus autofluorescence, fluorescein angiography, optical coherence tomography, while in research adaptive optics reveal detailed phenotypic characteristics, notably in retinal pigment epithelium changes and photoreceptor disruption. The phenotypic of PARD variability presents diagnostic challenges, with phenotypic features often overlapping with other retinal diseases including age-related macular degeneration, Stargardt disease and retinitis pigmentosa. ConclusionThis review emphasizes revising diagnostic criteria by incorporating more recent imaging techniques and confirming diagnosis with the use of genetic testing. Understanding phenotypic diversity and intrafamilial variability in PARD is crucial for developing new treatments and for patient prognosis and future research should focus on larger cohorts studying genotype-phenotype correlations.

The safe lowest effective power of subthreshold micropulse laser treatment in Chinese patients with acute or chronic central serous chorioretinopathy.

To assess the safe, lowest effective laser power of subthreshold micropulse laser (SML) for treating acute and chronic central serous chorioretinopathy (CSC) in Chinese patients. Patients were distinguished with acute or chronic CSC based on focal or diffuse retinal pigment epithelium (RPE) leakage on fundus fluorescein angiography (FFA), with or without widespread RPE decompensation. Patients were categorized into five groups and treated with 577 nm yellow SML according to 50% titration power. The change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) were set as primary outcomes. A linear regression model assessed the correlation between different factors and outcome indicators. A total of 103 patients with 127 eyes (61 with acute CSC and 66 with chronic CSC) were enrolled. The baseline characteristics were balanced between the five groups (all p > 0.05). The decrease of CMT and the improvement of BCVA were related to the CMT at baseline (all p < 0.05). We found that the lowest effective laser power for acute CSC was 425 mW (-225.50 μm vs. -171.24 μm vs. -114.50 μm vs. -130.54 μm vs. -68.00 μm, p < 0.001), showing a significant CMT reduction at this power, but no significant increase in BCVA (-0.15 ± 0.10 logMAR vs. -0.20 ± 0.16 logMAR vs. -0.14 ± 0.11 logMAR vs. -0.17 ± 0.30 logMAR vs. -0.11 ± 0.14 logMAR, p > 0.05). For chronic CSC, the lowest effective laser power was 375 mW (p = 0.01), the change of CMT was significant in 375 mW (-93.91 ± 109.06 μm, -119.32 ± 105.56 μm, -88.67 ± 67.26 μm, -60.89 ± 106.86 μm, and -99.11 ± 157.32 μm, p = 0.04). The change of BCVA was similar trend (-0.54 ± 0.66 logMAR vs. -0.17 ± 0.23 logMAR vs. -0.10 ± 0.21 logMAR vs. -0.02 ± 0.30 logMAR vs. 0.05 ± 0.19 logMAR, p < 0.001). In this study, our results suggested 425 mW and 375 mW laser power is the lowest effective SML power for treating acute and chronic CSC in Chinese patients respectively, And the power of SML for chronic CSC requires lower power than acute CSC.

Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Posterior Septal Artery Perfusion in Endoscopic Skull Base Surgery

Abstract Background Nasoseptal flaps (NSF), perfused by the posterior septal artery (PSA), are heavily utilized in endonasal skull base surgery (ESBS). We use indocyanine green (ICG) fluorescence angiography to assess PSA perfusion. Methods A prospective study of adult ESBS patients assessed PSA perfusion using intraoperative ICG. PSA ICG fluorescence intensities (FIs) were quantified. Factors analyzed included demographics, comorbidities, prior sinonasal surgery, surgical approach, concurrent septoplasty, NSF harvest timing, and flap-related complications. t-Tests compared significant ICG baseline differences and changes from baseline. ICG enhancement was compared with postoperative magnetic resonance imaging (MRI). Results A total of 54 patients were studied. Of these, 35 NSFs were harvested, while the remaining 19 underwent cuts for rescue flaps. Mean PSA FI changed from baseline 118.1 ± 28.6 to 114.4 ± 32.3 following reconstruction. Tobacco users had lower baseline FI compared with non-tobacco users (78.3 ± 62.8 vs. 118.4 ± 29.1, p = 0.003). Transpterygoid approaches showed greater decrease from baseline (−25.8 ± 58.9 vs. −3.8 ± 32.1, p = 0.035) than transsphenoidal. No other studied factors, including revision case, timing of flap harvest, flap side, division of palatosphenoidal artery, or concurrent septoplasty, had a significant influence on ICG intensity. In total, 34 of 35 NSFs were viable. ICG fluorescence had a 100% sensitivity, 0% specificity, and 96.6% positive predictive value (PPV) for NSF viability, while MRI enhancement had a 100% sensitivity, 100% specificity, and 100% PPV for NSF viability. Conclusion ICG angiography may provide an intraoperative assessment of flap viability with comparable PPV as postoperative MRI. Tobacco use and transpterygoid approaches may be associated with decreased PSA perfusion.

Blue light reflectance imaging in non-perfusion areas detection: insights from multimodal analysis

DesignA retrospective, cross-sectional image analysis using a convenience sample.SubjectsFive cases selected based on the availability of comprehensive imaging data.MethodsThis study involved a retrospective review of images from five cases, focusing on the use of retinal monochromatic blue light reflectance (BLR) imaging to detect non-perfusion areas. Two cases of sickle-cell retinopathy demonstrated peripheral retinal non-perfusion identified through widefield fluorescein angiography. Three other cases—one with branch retinal vein occlusion, one with branch retinal artery occlusion, and one presenting paracentral acute middle maculopathy showed focal macular non-perfusion detected by structural OCT and OCTA. The areas of nonperfused retinal tissue, confirmed by fluorescein angiography, OCT, and OCTA, were then correlated with findings from the BLR image. This correlation aimed to identify any potential associations between these imaging modalities.Main outcome measuresEnhance understanding of the utilization of retinal monochromatic BLR images as a non-perfusion biomarker.ResultsThe perfusion defects identified through fluorescein angiography were qualitatively correlated with hypo-reflective regions observed in the BLR images. A notable correlation was also observed between the OCTA deep capillary plexus findings and the BLR images. Additionally, areas of retinal thinning identified on structural OCT thickness maps corresponded with the hypo-reflective regions in the BLR images. This indicates the potential of BLR in identifying non-perfused retinal areas.ConclusionsThis study reinforces the evidence, through OCT, OCTA, and angiographic correlation, that the BLR can effectively identify areas of retinal non-perfusion in a non-invasive manner. Further research is warranted to assess the method’s sensitivity, specificity, and limitations. While the interaction of blue light with the retina, leading to specular reflections and scattering, is established, this research represents a pioneering effort in suggesting which specific retinal structures may be implicated in this phenomenon. This novel insight opens avenues for deeper exploration into the underlying mechanisms and potential clinical applications of utilizing the BLR imaging technique for assessing retinal vascular abnormalities.

Fluorescein angiography patterns and subretinal hyperreflective material predict subthreshold micropulse laser response in chronic central serous chorioretinopathy

BackgroundTo investigate predictors of navigated subthreshold micropulse laser (SML) treatment in chronic central serous chorioretinopathy (cCSC).MethodsIn this single-center prospective consecutive case series, patients with cCSC were treated with 577 nm SML and followed up for 12 months. A complete ophthalmological evaluation including spectral optical coherence tomography (SD-OCT), fluorescein angiography (FA) and microperimetry (MP) was performed. FA hyperfluorescence patterns and SD-OCT features were investigated.ResultsOverall, 38 eyes from 38 patients affected by cCSC with a mean age of 48.20 ± 5.95 years were included. Thirty-one eyes (81.6%) demonstrated a significant subretinal fluid (SRF) reduction after treatment at 3 months. Complete SRF resolution was achieved by twenty-three patients (60.5%) at 3 months and attained by an additional patient (24 in total, 63.2%) at 6 months. Twenty-two (57.9%) of such individuals were confirmed with no SRF at the end of the follow-up. Best-corrected visual acuity improved significantly and progressively at all timepoints from baseline, in parallel with macular sensitivity (all p: <0.005). Logistic regression analysis revealed that the presence of subretinal hyperreflective material (SHRM, p: 0.044; OR: -0.225; 95% CI: -0.448 - -0.003) and focal hyperfluorescence pattern on FA (p < 0.001; OR: 0.438; 95% CI: 0.196–0.632) predicted poorer and better treatment response, respectively.ConclusionsFA hyperfluorescence pattern and presence of SHRM may predict SML treatment response in cCSC patients.